Study finds career flexibility important among male and female physicians across generations

With increasing expectations from younger generations that careers be more family-friendly and to help address the predicted physician shortage in coming decades, academic medical centers nationwide are looking for ways to strengthen faculty workplace policies to attract and retain physicians.

A UC Davis School of Medicine study, published in the July 1 print edition of the American Journal of Medicine, has found that career-flexibility policies may be an important strategy to reduce faculty turnover and improve work-life balance.

The UC Davis study found a high level of support for career flexibility policies among both sexes and across generations among UC Davis School of Medicine faculty. However, younger men and older women reported the lowest satisfaction with career policies. The findings provide insights into high-risk groups who may be experiencing work-life balance challenges and could inform efforts to improve faculty career satisfaction.

"To our surprise, faculty of all generations and both genders are supportive of career-flexibility policies ― even if they are unlikely to take advantage of their benefits," said Lydia Pleotis Howell, professor and chair of pathology and laboratory medicine and co-principal investigator of the study along with Amparo Villablanca, professor of cardiovascular medicine. "But also surprising was that younger men and older women were less satisfied than other groups, showing that their needs are not being met."

The study examined data from a detailed 2010 survey of 325 School of Medicine faculty members regarding their attitudes, awareness and use of career-flexibility policies. The analysis divided the faculty by gender and age to correspond with the baby-boomer generation (older than 50) and the Generation-X group (younger than 50). The school has flexible career policies in place that include leave policies for childbirth, adoption and elder care. Opportunities for part-time work, tenure-clock extension and deferral of academic reviews are also available.

Family-friendly policies are expected to mostly be used by young women having children, but even the majority of older men ― 69 percent ― indicated that they might one day make use of the policies. More than 83 percent of faculty in all generations and both sexes reported that such policies enhance their career satisfaction even if they would never use the policies. Respondents indicated that such policies are important for recruiting and retaining faculty, and that they are important for career advancement as well as work-life balance.

In terms of overall satisfaction with flexible career policies, older women and younger men were found to be somewhat less satisfied than their colleagues. Howell and Villablanca plan to pursue possible reasons for these differences in future research. They speculate that young men have higher expectations to be primary breadwinners and advance quickly in their careers, at the same time trying to be more attentive fathers and husbands than men in the previous generation. Unlike young mothers, their colleagues might not be as understanding of the need to give family higher priority. Older women, on the other hand, are often juggling the needs of their young adult children and elderly parents with their career responsibilities.

"It is important to figure out why these groups are more dissatisfied," said Howell. "It is possible that policies can be tailored to better fit their needs."

The Association of American Medical Colleges is predicting a physician shortage in the future, as one in three active physicians is expected to retire by 2020. Academic institutions, which traditionally require long hours and on-call duties, as well as considerable teaching demands and high expectations for research accomplishment, face particular challenges in attracting and keeping faculty. A study conducted at another major academic center that the UC Davis authors cite had a 24 percent average turnover rate in new physician hires, with only 55 percent of initial recruits retained five years later.

Howell believes that the business community has been successful in offering flexible workplace policies to enhance work-life balance without sacrificing excellence and productivity. She thinks academic medical centers can learn from those experiences and apply them to the physician workforce. For example, certain faculty may be able to perform some of their duties from home, using telemedicine technologies and electronic medical records.

"Flexibility has become a strong strategy in other industries to avoid the costs of rapid turnover," said Howell. "Academic medicine may also need to start thinking differently to recruit and retain workers."

Nathan Kuppermann, professor and chair of emergency medicine at UC Davis Health System, used family leave when each of his two daughters was born, but did not do so more recently when he and his wife adopted a toddler.

The difference? "This time around I was running the department and simply couldn't take off," he said.

Kuppermann and his wife, UC Davis pediatric endocrinologist Nicole Glaser, have led workshops on work-life balance especially targeted to two-physician couples. He has found that the use of flexible career policies depends a lot on recognition and encouragement from the department chair. He has also learned that family-friendly efforts go beyond maternity or elder care leave. For example, departments can expect more attendance at faculty meetings by scheduling them during normal working hours, rather than at 7 a.m. or at 5 p.m.

"Younger faculty members especially expect to be able to have more time with their families," said Kuppermann. "They want breakfast with their kids and to pick them up at the end of the day."

Other authors include Laurel A. Beckett and Jasmine Nettiksimmons from the Department of Public Health Sciences at UC Davis.

Funding for the study was provided by the National Institutes of Health (grant number 1R01GM88336-01) in partnership with the Office of Women's Health Research.

The UC Davis School of Medicine is among the nation's leading medical schools, recognized for its research and primary-care programs. The school offers fully accredited master's degree programs in public health and in informatics, and its combined M.D.-Ph.D. program is training the next generation of physician-scientists to conduct high-impact research and translate discoveries into better clinical care. Along with being a recognized leader in medical research, the school is committed to serving underserved communities and advancing rural health. For more information, visit UC Davis School of Medicine at medschool.ucdavis.edu.